One of the USF College of Public Health’s largest and fastest-growing departments is also its newest. Founded in 2004, the Department of Global Health already has become one of the largest COPH departments in terms of total enrollment, said Dr. Thomas Unnasch, department chair.
The department initially was formed by a collaborative effort between faculty in the Department of Environmental and Occupational Health and the Center for Biological Defense.
Before that, there was a trans-college track in global health under the direction of Dr. Jeannine Coreil that did not belong to any department. It was designed for students interested in the international and global aspects of public health. The interim dean, Dr. Stan Graven, felt the need for a new department that would satisfy student demand for both tropical diseases and public health practice in low-resource settings and international health systems.
“Several people in Environmental and Occupational Health became interested more in global and infectious disease issues,” Unnasch said. “Dr. Jacqueline Cattani, the director of the CBD, Dr. Boo Kwa, a professor in Environmental and Occupational Health, and the incoming dean at that time, Dr. Donna Petersen, began discussing establishing a new department of global health.”
“There was a need for a new department,” said Dr. Boo Kwa, associate dean for International Programs and Global Health’s founding chair. “The students themselves were asking for more programs with a global health perspective. They were interested in going to Brazil to look at malaria, going to Africa to look at African sleeping sickness, looking at filariasis in Southeast Asia. So it made sense to have a new department.
“The dean then asked me to start a series of meetings within the college to do a needs assessment, both with the other faculty and with the student body. There was overwhelming support among the students for a new department of global health, and also majority support from the faculty.
“So in 2004, the new department was formed from faculty coming from different departments – primarily from Environmental and Occupational Health, but also some from Community and Family Health.”
Unnasch added that the CBD provided much of the funding for the build-out of the laboratories in the interdisciplinary research building, where the primary wet-lab research is conducted.
With a building, a small faculty and a limited budget, the Department of Global Health was in business.
Initially, Kwa said, there were six faculty members in two programs: communicable diseases (parasitology, microbiology and immunology) and global health practice (international health systems, comparative studies and methodology, especially methodological strategies in low-resource countries). Three of the six were “very junior faculty,” he said, but they were part of something no other university had.
“When we started out, I believe we were among the first actual departments of global health, if not in the world, certainly in the United States,” he said. “Other colleges of public health may have had small programs, but to my knowledge, we were the first to actually start a global health department.”
With the encouragement of the dean and strong institutional support in general, Kwa began a fruitful hunt for talent, and a flood of top-notch faculty hirings soon ensued.
“The first world-class tropical disease person we brought in was Dr. Dennis Kyle, who was an eminent malariologist from the Walter Reed Institute,” Kwa said. “Once he came, it was a lot easier to recruit the second person, who was John Adams, who was also a malaria person, and then Tom Unnasch, also a mosquito-borne disease specialist, and then Wil Milhous, another world-class malaria expert, and then Bob Novak, who is a renowned medical entomologist.
“We started having a critical mass of really eminent global communicable disease experts in the department,” Kwa said. “They brought in a lot of research funding. They brought in big teams of post-doctoral researchers and post-doctoral students and built a really world-class global communicable disease research program in six or seven years.
“The growth period was tremendous. In terms of research,” he said, “we went from very little funding to multimillion-dollar funding over a very short period of time. Between 2006 and 2012, we just grew spectacularly.”
Kwa estimates the department’s current funding at $15-20 million a year. Three Global Health professors – Unnasch, Adams and Kyle – are ranked among USF’s best externally-funded investigators in terms of research dollars, and two are in the top five.
Unnasch said that much of Global Health’s research funding comes from external grants from the National Institutes of Health, primarily the National Institute of Allergy and Infectious Diseases.
The Bill and Melinda Gates Foundation has come through with what he called “a substantial portfolio of funding”: a $4.5-million grant to Adams this year for developing new drugs and researching new genetic targets for malaria, a similar-sized grant to Kyle, and a $2-million grant to Unnasch for studying black flies as disease vectors.
Unnasch also has been funded by the Carter Center in recent years to address one of its biggest global missions – the elimination of river blindness.
Additionally, Kyle and Adams have established collaborations with the Draper Laboratory to conduct research with artificial livers to study malaria in livers, which also is funded by the Gates Foundation, he said.
The combination of expertise and generous funding has helped put the department on the global cutting edge and in the thick of international connections that will help keep it there.
“The department is becoming quite well known now as a research institution for malaria and other vector-borne diseases,” Unnasch said. “We have lots of good collaborations with people in Thailand at Mahidol University, and a lot of collaborations with people in Africa. There’s also quite a bit of contact between our department and people in the mosquito control field here in the state of Florida.”
Unnasch said those include regular work with the Florida Mosquito Control Association (of which Unnasch is on the board of directors), the Department of Health Laboratories (located in the Doc Myers Building), the Florida Department of Health, and various research projects with mosquito control in Hillsborough, Pasco, Manatee, Volusia and St. Johns counties, as well as with the Florida Keys Mosquito Control District in Monroe County.
For mosquito researchers, Unnasch said, the reason is obvious. For everyone else, it might be alarming.
“Florida’s the best place in the country if you want to do research on mosquito-transmitted diseases,” he said. “There are four arthropod-borne viruses, or arbovirus, infections that occur in the United States, and three out of the four are endemic to Florida.
“The most deadly virus that we have is Eastern Equine Encephalitis virus. Forty percent of the human cases historically that have occurred in the United States have occurred in the state of Florida. Florida has more EEEV activity than any other state in the country, by far – almost as much as all the other states combined. That’s why Florida spends $75-100 million a year on mosquito control. Only California spends more.”
If that isn’t enough to underscore the importance of what Global Health does, Unnasch has more.
“Of course, we’re just sitting here on pins and needles to see how the recent introduction of chickungunya will develop,” he said. “It’s a raging epidemic in the Caribbean and has recently been reported here in Florida, as well.”
Despite a full plate of research initiatives and graduate-level instruction, the department made another cutting-edge decision to take on more.
“This department took the lead in teaching undergraduates,” Unnasch said. “We were one of the first departments in the college to offer undergraduate minors and concentrations.”
In 2013, a public health minor and certificate in Community Engagement in Homeland Security and Emergency Management was added to undergraduate offerings. Enrollment started at 60 the first year, then doubled to 120 this year, said Elizabeth Dunn, assistant to the director.
Aside from continuing rapid growth, Unnasch said he sees Global Health’s future shaped by a paradigm shift from controlling the so-called neglected tropical diseases to eradicating them.
“I see us at the forefront of developing technologies and researching new tools and drugs that can be used to push forward this elimination mandate that the WHO and the other international organizations are moving forward,” he said.
Another big piece of the department’s future, as he sees it, will be dictated by the coming genomic revolution. The genetic mapping of individuals to help determine how best to keep them healthy or treat their ailments comes inherent with calculating their health risks.
“The ethical implications are profound,” Unnasch said. “When you have that kind of information, whom do you share it with? Should your insurance company know? What would they do with it?
“I see our department taking the lead in developing new classes and educating a new group of public health professionals in this new technology that is going to revolutionize everything about medicine and public health. We already have two faculty members in our department who are very interested in this area, one of whom is our latest hire, Dr. Jiang, a bioinformatics expert from MIT and the Broad Institute.”
A new course in the basics of genomics debuted in the fall, Unnasch said, and recruitment has begun for new joint faculty position with the Department of Health Policy and Management to develop and teach the ethics classes.
Among the department’s other plans for its busy future are a graduate certificate in homeland security, development of an emergency response training course for individuals and emergency managers with a public heath approach to community resilience, and a partnership with the Center for Homeland Defense and Security and the Naval Postgraduate School in providing students access to the Homeland Security digital library.
Global Health’s future also is naturally tied to its ongoing missions. The department’s researchers will continue striving to develop what Kwa calls “the holy grail for malaria.”
To that end, he said, Adams’ work with genetics is a global breakthrough. Although there are a few vaccines in existence, Kwa said, none are suitable for remote areas, and those are the areas with the greatest need.
“The ideal is to get a malaria vaccine that is cheap, that is easily transportable, that does not need refrigeration, and that can be given by the oral method,” Kwa said. “When it reaches that stage, then we will have a workable, feasible, practicable, effective vaccine. As long as it’s expensive and needs sterile conditions and so on, it’s not going to be able to get to the people who need it.”
He also sees the department standing out from its counterparts by continuing its war on diseases that are off the beaten path.
“Most of the research is for cancer and heart disease, and even for infectious diseases, most other universities emphasize only HIV, and secondly, tuberculosis, but the neglected diseases are things like river blindness and guinea worm,” he said. “This is an area where I think we’ve found a niche because we have really world-class scientists working in this field.”
In one sense, this groundbreaking department comes full circle to a future that lies in its brief but remarkable past. It is, after all, a living prototype.
“A lot of other universities are trying to establish similar departments,” Unnasch said. “I get a lot of calls about that and how to go about it. I guess we know a bit about that here.”
Story by David Brothers, College of Public Health. Photos courtesy of Drs. Ismael Hoare, Benjamin Jacob, Boo Kwa and Thomas Unnasch.